Why local government should be taking a close look at the Health and Social Care Bill – part two

From the media coverage this week on the about-to-be-published Health and Social Care Bill, and listening to speeches from David Cameron and Andrew Lansley, you might be forgiven for thinking the ‘social care’ part of the title was a mistake – no-one mentioned social care. And the King’s Fund have just set out ten questions to ask about the Bill which totally ignore social care and anything directly about the new roles for local authorities in health.

Of course, the mega issues are the speed of the health reforms, especially given the economic context, the transfer of commissioning to GP consortia and the debate around marketisation. But none of these are irrelevant to local government and local government is not irrelevant to the ultimate effectiveness of the reforms.

We know much of what is going to be in the Bill, but like the budget (and the Localism Bill for that matter) the devil may be in the details. So why not look at questions for local government to ask about this Bill? Here are ten for starters:

• How exactly does the Health and Social Care Bill extend the powers of local authorities to enable scrutiny of any provider of any NHS-funded service, such as primary medical dental or pharmacy services and independent sector treatment centres?
• What more does the Bill tell us about local commissioning arrangements and the powers of health and wellbeing boards – how effective, for example, do the provisions seem that require GP consortia (among others) to contribute to joint strategic needs assessments?
• What will happen about joint commissioning and use of Section 75 arrangements between the NHS and local government?
• Have the government changed their minds and decided district council representatives should have a statutory place on health and wellbeing boards (unlikely but you never know)?
• Does the Bill provide greater clarity over HealthWatch England and Local HealthWatch?
• Does the Bill further clarify the respective roles of the Secretary of State, the NHS Commissioning Board and local authorities in relation to public health – following the consultation on funding and commissioning of public health?
• Who will have responsibility for tackling health inequalities, which structures will support this work and what powers and duties will councils have in relation to health inequalities?
• What does the Bill tell us about whom local authorities should now be developing relationships with  – ie who will be the key players and movers and shakers in the new structures?
• How will the proposed legal framework facilitate (or not) the government’s stated objective that “local authorities will take on the major responsibility of improving the health and life-chances of the local populations they serve”? That is – how genuinely localist is this Bill in relation to devolving these responsibilities to local government?
• And finally and more generally, does the Bill give us a clear indication about how health, public health and social care will relate to each other once these reforms are implemented?

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